This month, the IAMSE Publications Committee review is taken from the article titled The Impact of Changing Step 1 to Pass/Fail Reporting on Anxiety, Learning, Approaches, and Curiosity, published in Medical Science Educator (September 18, 2023). The study was conducted by LeClair, R.J., Binks, A.P., Gambala, C.T., Brenner, J.M., Willey, J.M.
In 2022, the USMLE Step 1 exam transitioned from numerical scoring to pass/fail reporting—a decision aimed at improving student well-being and reducing the weight of Step 1 scores in residency selection. While the intent was clear, the broader consequences of this change are still unfolding across medical education. Early national data suggest some unintended ripple effects: a notable drop in Step 1 pass rates and a growing number of students choosing to defer the exam.
LeClair and colleagues set out to explore how this change impacted medical students. In this multi-institutional study across three U.S. medical schools, the authors examined how the shift to pass/fail scoring influenced pre-clerkship students’ anxiety, curiosity, grit, and learning strategies. They used validated survey tools to compare two cohorts—students from the Class of 2023 (who received numerical scores) and the Class of 2024 (who received pass/fail reports).
The findings challenge some early assumptions. While many expected a less stressful learning environment under the new system, the reality was more nuanced. Through careful statistical analysis, the study revealed a significant connection between the scoring format and students’ approach to learning.
One clear trend emerged: as Step 1 scores became irrelevant for residency applications, students began redirecting their focus to Step 2 CK, clerkship performance, and extracurricular achievements like research. This shift may have implications for how students engage with foundational sciences in the preclinical years.
For educators and curriculum leaders, this study offers important food for thought. As we strive to balance student wellness with academic rigor, it’s crucial to monitor how major assessment changes shape learning behaviors. This work serves as an early reminder that even well-intentioned reforms must be continually evaluated for their real-world impact.
Monzurul Roni, PhD
Teaching Associate Professor
Department of Health Sciences Education and Pathology
University of Illinois College of Medicine